Provider Demographics
NPI:1669424032
Name:AMBRAD-CHALELA, ESTEBAN (MD)
Entity type:Individual
Prefix:DR
First Name:ESTEBAN
Middle Name:
Last Name:AMBRAD-CHALELA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:761 WILLIAMS BLVD.
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99354
Mailing Address - Country:US
Mailing Address - Phone:509-946-9707
Mailing Address - Fax:509-946-8145
Practice Address - Street 1:761 WILLIAMS BLVD.
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99354
Practice Address - Country:US
Practice Address - Phone:509-946-9707
Practice Address - Fax:509-946-8145
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000391982086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1124833Medicaid
WAG97329Medicare UPIN